President's Message

By Al Stammers, MSA, CCP
AmSECT President

Predicting the fu­ture has been described as a best guess based upon incomplete facts from questionable sourc­es, bathed in bias and steeped in opinion. During the past six to seven years we have seen, read and heard numerous exposes from pundits on every aspect of cardio­vascular perfusion. Those of us who go back even further remember many of the predictions that were made signaling both the boom (Inability of Percuta­neous Interventions from the Cardiac Catheteriza­tion Laboratory in the Treatment of Acquired Heart Disease) and the doom (The Heart Lung Machine is an Independent Risk Factor in the Development of Morbidity Post-Cardiac Surgery) of perfusion technology. What is reality rests somewhere in between, which although not quite as demoralizing, is surely not a signal that all is well.

First some facts: 1. Atherosclerotic heart dis­ease continues to be a major morbidological event of westernized civilization and is increasing in areas of the world that are prospering from increased consumerism. 2. Acquired cardiac valvular disease is increasing with more patients likely to require surgical interventions in the next decade. 3. The rate on inherited congenital heart defects remains constant with eight children for every 1,000 live births being born with a defect requiring intervention. Baby boomers are blooming, including this boomer, and we assume that our generation has failed to learn from the errorsof the lifestyles of our parents and grandparents, and will require the same degree of care that we administer to them today. Although most moralists would hardly approve of the jubilance we show towards this burgeoning increase in the clinical need for perfusion, those of us vested in the delivery of such service breathe a sigh of relief when contemplating the future. How smart is this? Again, the $64,000 question that demands closer scrutinization.

Despite the continued prevalence of coronary artery disease, the rate of surgical intervention continues to decline. The decline has averaged somewhere between 5% and 8% during the past five years and is predicted to drop an additional 30% in the near future. This prediction is somewhat conservative and is based upon the increase in the application of drug eluting stents. However, an ad­ditional factor in this predictive equation is the effect of continued advances in research in molecular treatments for heart disease. Valvular heart disease is on the rise, but so are companies that produce catheterization-based interventions. There are over 25 percutaneous heart valves in some phase of development and clinical trials with all valve companies investing huge R&D funds into their development. The spillover effect to congenital heart disease is only hampered by the low number of procedures performed worldwide, with investors instead focusing on economic returns from the adult population. However, this reprieve will be short-lived and eventually the development of these devices will catch up to that of adults. One need look no further than the cardiac surgery fellowship programs to see the large number of seats that go unfilled each year and the development of ‘hybrid’ educational programs for entering cardiac surgeons that emphasize endovascular interventions and percutaneous techniques during their education. Of course, no one knows what the long-term outlook for these interventions will be, but following a ‘wait and see’ phenomena may be akin to showing up for a wedding and instead, finding yourself at the 25th anniversary party. AmSECT has decided not to ‘hope for the best’ but to become proactive in addressing the future.

To this, AmSECT has convened a Taskforce to review the current Scope of Practice and to assess its completeness in preparation for the future. The current Scope of Practice is heavily weighted towards the heart lung machine, reflecting the historical importance of this device in perfusion practice. Although the heart lung machine will maintain its position as the cornerstone in the edification of our profession, like most hospitals throughout the world, it will be modified with structural additions that accent its core function. The Taskforce is charged with reviewing each of the existing areas listed in the Scope of Practice and modifying them to meet what perfusionists are doing today, and most importantly, identifying what we will be doing in the next five years. No trivial task and no small undertaking.

The Taskforce met in Las Vegas and began the process of revising the Scope of Practice. The initial meeting identified clinical areas that perfusionists were involved in, both inside and outside, the operating room. They will again convene on Wednesday, August 23, 2006 from 8:00 am until noon, in Jackson Hole, Wyoming at the 14th Annual New Advances in Perioperative Blood Management meeting and one last time in Bellevue, Washington at the Best Practices meeting on October 5, 2006 from 8:00 am until noon. We are looking for volunteers to serve in this most important of functions and invite anyone who is interested to contact AmSECT or myself to join us. One does not need to be a member of AmSECT to join.